The Jan. 12 guest opinion by Jeff and Natalie Newgard “Insurance should cover patients’ forced change in hospitals” was certainly topical. Labor and delivery units all over the Portland metro area are straining under staffing shortages caused by the COVID-19 pandemic, which have become more acute during the latest combined delta and omicron variant surge. Of course, insurance companies need to cover the costs when patients are transferred to an out-of-network hospital; any reasonable person would expect that.

But the bigger question is this: Why don’t all insurance companies cover all hospitals and providers all of the time? This was the case before the 1980s. “Managed care” emerged and forced physicians and hospitals to contract with insurance companies, supposedly to provide more cost-effective care. This has never actually provided the monetary windfall we were promised. But it has forced patients to change providers every few years as their employers contract with different insurance companies. This patient “churn” is extremely inefficient, expensive and quite unnecessary. Many countries have achieved nearly universal health care coverage with open-panel insurance plans. We do not need to institute a “single-payer system” to fix this problem. Just make the insurance companies into insurance companies again, and let the patients choose their providers. Competition based on quality of care would be better for everyone. Marguerite Cohen, M.D., Portland

Cohen is a fellow of the American College of Obstetricians and Gynecologists